认知行为疗法治疗失眠可减少癌症幸存者的抑郁。
Cognitive Behavioral Therapy for Insomnia Reduces Depression in Cancer Survivors.
机构信息
Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, New York.
Departments of Psychology and Oncology, Memorial University, Newfoundland, Canada.
出版信息
J Clin Sleep Med. 2019 Jan 15;15(1):129-137. doi: 10.5664/jcsm.7586.
STUDY OBJECTIVES
The current archival analyses examine the direct and indirect effects of cognitive behavioral therapy for insomnia (CBT-I) on depression in cancer survivors.
METHODS
We report on 67 cancer survivors from a 2 × 2 randomized controlled trial of CBT-I and armodafinil for insomnia, after collapsing across the noneffective study medication conditions (armodafinil/placebo) to create CBT-I (yes/no). Depression and insomnia were assessed before, during the 7-week CBT-I intervention, at postintervention, and 3 months later by the Patient Health Questionnaire and the Insomnia Severity Index, respectively.
RESULTS
Mean depression at baseline for all participants was 6.44 (standard error = 0.41, range 0-15). Paired tests showed that depression improved from baseline to postintervention by 48% ( < .001) in the CBT-I group versus 15% ( = .016) in the non-CBT-I group. Analysis of covariance controlling for baseline found that participants receiving CBT-I had significantly less depression at postintervention (effect size = -0.62; = .001), compared to those who did not receive CBT-I. These benefits were maintained at the 3-month follow-up. Spearman rank correlations showed that changes in insomnia severity from baseline to postintervention were significantly correlated with concurrent changes in depression ( = .73; < .001). Path analysis revealed that improvement in depression was mediated by improvement in insomnia severity ( < .001).
CONCLUSIONS
Our findings provide preliminary support that in cancer survivors, CBT-I reduces depression via improvement in insomnia. Further, this reduction in depression remained stable 3 months after completing CBT-I. This suggests that a CBT-I intervention has a meaningful effect on depression.
CLINICAL TRIAL REGISTRATION
Registry: ClinicalTrials.gov; Title: Cognitive Behavioral Therapy +/- Armodafinil for Insomnia and Fatigue Following Chemotherapy; Identifier: NCT01091974; URL: https://clinicaltrials.gov/ct2/show/record/NCT01091974.
研究目的
本存档分析考察了失眠认知行为疗法（CBT-I）对癌症幸存者抑郁的直接和间接影响。
方法
我们报告了一项针对失眠的 CBT-I 和阿莫达非尼的 2×2 随机对照试验中的 67 名癌症幸存者，该试验将无效的研究药物条件（阿莫达非尼/安慰剂）合并为 CBT-I（是/否）。抑郁和失眠分别通过患者健康问卷和失眠严重程度指数在干预前、7 周 CBT-I 干预期间、干预后和 3 个月后进行评估。
结果
所有参与者的基线平均抑郁评分为 6.44（标准误差=0.41，范围 0-15）。配对 t 检验显示，CBT-I 组的抑郁从基线到干预后改善了 48%（<0.001），而非 CBT-I 组仅改善了 15%（=0.016）。控制基线的协方差分析发现，接受 CBT-I 的参与者在干预后抑郁程度明显低于未接受 CBT-I 的参与者（效应大小=-0.62；=0.001）。这些益处在 3 个月随访时得以维持。Spearman 等级相关分析显示，从基线到干预后的失眠严重程度变化与抑郁的同时变化显著相关（=0.73；<0.001）。路径分析显示，抑郁的改善是通过失眠严重程度的改善来介导的（<0.001）。
结论
我们的研究结果初步支持了在癌症幸存者中，CBT-I 通过改善失眠来减轻抑郁。此外，在完成 CBT-I 后 3 个月，这种抑郁的减轻仍然稳定。这表明 CBT-I 干预对抑郁有显著的影响。
临床试验注册
注册机构：ClinicalTrials.gov；标题：化疗后失眠的认知行为疗法 +/- 阿莫达非尼；标识符：NCT01091974；网址：https://clinicaltrials.gov/ct2/show/record/NCT01091974。
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